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Changes in myocardial work associated with pediatric kidney transplantation: A pilot study of short-term

Fei Xiao1, Rui Fan1, Jingwei Zhang1

  • 1Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Journal of Clinical Hypertension (Greenwich, Conn.)
|November 11, 2022
PubMed

Insights

Kidney transplantation improved left ventricular (LV) myocardial work (MW) in children, with significant gains in global MW index, constructive MW, and wasted MW. However, some parameters remained impaired compared to healthy peers.

Area of Science:

  • Cardiology
  • Nephrology
  • Pediatric Medicine

Background:

  • Children with Chronic Kidney Disease (CKD) stage 5 often experience cardiac complications.
  • Left Ventricular (LV) myocardial work (MW) is a sensitive indicator of cardiac function.
  • Kidney transplantation (KTx) aims to improve overall health outcomes in pediatric CKD patients.

Purpose of the Study:

  • To evaluate changes in LV myocardial work (MW) in children with CKD stage 5 within 3 months post-kidney transplantation (KTx).
  • To compare LV MW parameters between pediatric KTx recipients and healthy children.
  • To identify factors influencing LV MW recovery after KTx.

Main Methods:

  • Echocardiography was used to assess cardiac structure, function, and LV MW before and after KTx in 43 pediatric recipients.
  • Clinical characteristics and laboratory parameters were collected.
  • LV MW parameters including global MW index (GWI), constructive MW (GCW), wasted MW (GWW), and MW efficiency (GWE) were analyzed.

Main Results:

  • Significant improvements were observed in GWI, GCW, and GWW (p < .01) post-KTx.
  • LV ejection fraction (LVEF) and LV mass index (LVMi) also improved significantly (p < .05).
  • Despite improvements, KTx recipients showed higher blood pressure, LVMi, GWW, and lower GWE compared to healthy children.

Conclusions:

  • Kidney transplantation partially restores LV myocardial work in pediatric patients.
  • LV MW parameters are more sensitive than global longitudinal strain (GLS) for assessing systolic function recovery post-KTx.
  • Close monitoring and timely treatment adjustments are crucial for patients with insufficient MW improvement to prevent irreversible myocardial injury.

Keywords:
cardiac functionchronic kidney diseasekidney transplantationmyocardial workpediatric

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